Factors Driving Antimicrobial Resistance in Rural Bangladesh: A Cross-Sectional Study on Antibiotic Use-Related Knowledge, Attitude, and Practice Among Unqualified Village Medical Practitioners and Pharmacy Shopkeepers

Abstract

Introduction Inappropriate antibiotic use in community settings significantly contributes to antimicrobial resistance (AMR) globally, compromising the quality of life and threatening public health. This study aimed to identify AMR contributing factors by analyzing the knowledge, attitude, and practice (KAP) of the unqualified village medical practitioners and pharmacy shopkeepers in rural Bangladesh. Methods We performed a cross-sectional study where the participants were pharmacy shopkeepers and unqualified village medical practitioners aged ≥ 18 years and living in Sylhet and Jashore districts in Bangladesh. Primary outcome variables were knowledge, attitude, and practice of antibiotic use and AMR. Results Among the 396 participants, all were male aged between 18 and 70 years, 247 were unqualified village medical practitioners, and 149 were pharmacy shopkeepers, and the response rate was 79%. Participants showed moderate to poor knowledge (unqualified village medical practitioners, 62.59%; pharmacy shopkeepers, 54.73%), positive to neutral attitude (unqualified village medical practitioners, 80.37%, pharmacy shopkeepers, 75.30%), and moderate practice (unqualified village medical practitioners, 71.44%; pharmacy shopkeepers, 68.65%) scores regarding antibiotic use and AMR. The KAP score range was 40.95–87.62%, and the mean score was statistically significantly higher for unqualified village medical practitioners than pharmacy shopkeepers. Multiple linear regression analysis suggested that having a bachelor’s degree, pharmacy training, and medical training were associated with higher KAP scores. Conclusion Our survey results demonstrated that unqualified village medical practitioners and pharmacy shopkeepers in Bangladesh possess moderate to poor knowledge and practice scores on antibiotic use and AMR. Therefore, awareness campaigns and training programs targeting unqualified village medical practitioners and pharmacy shopkeepers should be prioritized, antibiotic sales by pharmacy shopkeepers without prescriptions should be strictly monitored, and relevant national policies should be updated and implemented. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-023-02547-5.

Factors contributing to antibiotic misuse among parents of school-going children in Dhaka City, Bangladesh

“…Male parents and secondary-educated parents showed more positive attitudes than other groups, which is consistent with previous research conducted in the UAE and Tanzania on parents’ education levels 22 , 27 . Surprisingly, parental gender was significantly associated with positive attitudes in the present study; these results contradict the claims of previous studies conducted in the UAE, Tanzania, and Qatar 39 , 61 , 67 . Several factors could explain this observation.…”

“…To our knowledge, this is the first broad-range KAP-based study in Bangladesh on the misuse of antibiotics by parents of school-going children. Though, there are several studies conducted regarding antibiotic uses and misuses in Bangladesh 33 , 58 – 61 .…”